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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical management of inpatient services, including acute care, rehabilitation, and ambulatory surgery, while ensuring compliance with organizational policies. Proficient in collaborating with medical directors and supporting claims audits and appeals processes.
Highest-signal resume keywords
Doctor Of MedicineLicensed Medical Doctor - PennsylvaniaMedical Management Plan DevelopmentClaims Audits SupportCollaboration With Medical Directors
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
Office Administration SkillsAbility To Work In Clinical EnvironmentAbility To Travel As Required
Certifications & Qualifications
Doctor Of Osteopathic Medicine
Industry Keywords
Inpatient Activity ManagementEvidence Of InsurabilityOut-Of-Network CareMedical Appropriateness GuidanceDenials And Appeals Process
About the role
Key responsibilities & impact- Lead medical management of Health Plan inpatient activity, including acute inpatient, LTAC, observation, SNF, rehabilitation, and ambulatory surgery
- Develop and implement the Health Plan Medical Management Plan for inpatient services
- Collaborate with Health Plan Medical Directors to manage medical goals in each region
- Collaborate with Medical Directors for Medical Home and Informatics to implement and monitor the Medical Management Plan
- Support retrospective claims audits and claims checks
- Support Evidence of Insurability and Over Age Dependent processes
- Support Geisinger Home Health nurses on DME, Home Health, and rehabilitation issues
- Provide guidance on medical appropriateness, benefit application, level of care, and out-of-network care
- Ensure complete and timely documentation
- Participate in Medical Director On-Call, On-Duty, and Appeals Committee activities
- Administer the practitioner and provider appeals process
- Ensure quality, accuracy, and timely completion of correspondence related to denials and appeals
- Participate on the Plan Pharmacy and Therapeutics Committee
Requirements
What you’ll need- Doctor of Medicine or Doctor of Osteopathic Medicine (Required)
- Licensed Medical Doctor - State of Pennsylvania
- Office Administration skills
- Ability to work in a clinical and office environment
- Ability to travel as required
- Ability to satisfy job-specific obligations and comply with organization policies and procedures
Benefits
Comp & perks- Healthcare benefits for full-time and part-time positions from day one
- Vision insurance
- Dental insurance
- Domestic partner benefits
- Collaborative, cooperative, and collegial work atmosphere